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Inspired by his schoolteacher sister, the author uses report cards in his practice to ensure his patients receive preventive care and do their "homework" before follow-ups. Follow his best practice solution to learn what you have to do to get an A+ and download his report card to use at your practice.
During residency training, my director would always ask us about the status of our patients' preventive medicine regimens. His questioning drove home his point: Always monitor patients' routine preventive care in addition to their health problems. Doing so can be challenging, but it is an important aspect of our value as family physicians.
I was surprised when I first started to practice. Often, my new patients didn't know their cholesterol levels or whether they were up-to-date with preventive medicine. To help patients keep better track, I designed a booklet that outlined what screenings, such as cholesterol, mammograms, prostate specific antigen (PSA), and sigmoidoscopy, they should have and when they should be done.
I gave a booklet to each of my patients and asked them to bring it back to their annual physicals so I could update it. Patients seemed to appreciate this, and most would bring it to their annual exam.
For patients I followed for high cholesterol or diabetes, I would write cholesterol and glycosylated hemoglobin test results on a small piece of paper so they could take that information home. Sometime later, I read an article about giving patients a formal prescription, written on a regular prescription pad, for their diet and exercise plans. This gave patients something concrete and helped motivate them to follow my verbal instructions.
I liked this idea, so I incorporated it into my practice. I kept my instructions simple: Lose 5 pounds in 3 months. Start walking 5 minutes a day, and every few days add 1 minute. I explained to them that this course of action would benefit their bodies and help control their disease, whether it was diabetes, obesity, hypertension, high cholesterol, or something else.
THE REPORT CARD
Several patients in my practice were schoolteachers, and I felt connected to these patients because teaching also was my sister's profession. One day, one of my schoolteachers didn't score so well on her glycosylated hemoglobin number. I remarked, "If you were a student in my classroom, I would give you a failing grade," and the concept of a report card was born.
I decided to incorporate all my instructions into one format. With a report card, I could clearly show patients where they stood with their diabetes and/or cholesterol, along with giving them advice on their preventive medicine regimens and any other health recommendations. It is well known that patients only remember a small portion of what you tell them in the exam room. So having a written record to take home would help and motivate patients to do better, I hoped.
I created the report card on a half sheet of paper. My dedicated nurse fills in the raw data, and I decide the grades.
I also write down any medication changes, if necessary; instructions for weaning off of a medication that we are discontinuing; recommended reading; and areas to research. I can discuss and ensure that patients are up to date with preventive medicine by using the "are you due for" section.
Near the bottom of the report card, I include my recommendations, which I like to call "homework." I can quickly check off what recommendations apply to the patient. These include daily exercise, weight loss, and diet modifications.
THE FUN BEGINS
Being graded in school was motivating for most students, and I believe that we can use this technique to motivate our patients. I also believe that keeping this process lighthearted and humorous helps patients accept the message.
Sometimes, I threaten my patients with detention or a visit to the principal's office if they don't get better grades next time. I lightheartedly ask them to have their children or their spouse sign the report card and bring it back on the next visit.
Patients smile shyly while I chastize them or smile broadly when they get good marks. Some have said, "I never made grades this good in school. Thanks."
Patients tell me that they put their report cards on the refrigerator, just like they used to do with their children's report cards. Spouses and friends often will compare results and sometimes complain that I gave another patient an A+ and only gave them an A.
THE BENEFITS FOR US
Sometimes, we believe that our efforts to motivate and encourage patients to help themselves with their medical problems go unheard.
I have found that using this report card with my patients helps me to be more animated and effective in communicating the importance of what they can do to live longer, more enjoyable, more healthful lives.
I recommend that you use this tool with your patients, rather than merely telling them: "Your diabetes is out of control, and I'm going to have to put you on another medication." These words can come across as punitive, and patients may end up resenting the fact that they have to take one more pill.
This tool helps me have more fun in my practice. It keeps me motivated to encourage my patients to do the basic things that can really benefit their health.
We should give all of our patients a report card whenever we can so they can have a written record of their cholesterol, glycosylated hemoglobin, PSA, and other test results. Report cards also give us the opportunity to talk about preventive medicine with patients and ensure that they are up to date with current recommendations.
This may sound like a lot to add to an often-busy office visit, and I know that I don't always get to all of the recommendations for each patient at every visit. However, I can get to the important items for that day's visit and cover other recommendations at a future visit. This way, everything eventually will be addressed.
The author practices family medicine in Glen Falls, New York. Send your feedback to firstname.lastname@example.org. Also engage at http://www.twitter.com/MedEconomics and http://www.facebook.com/MedicalEconomics.
2012 Doctor's Writing Contest Winners